Firstly, it was demonstrated that subjects with cytogenetic aberrations associated with a favourable prognosis differed in methylation status to NK-AML subjects who are associated with an intermediate outcome. Next, it was shown that differences src inhibitor dasatinib exist in methylation patterns between subjects with NK-AML harboring an NPM1 mutation (a prognostic marker associated with improved outcome) and those without an NPM1 mutation. Interestingly, when the NPM1 status of all subjects were mapped onto the methylation profiles that separates favourable risk subjects from NK-AML subjects, clustering of subjects with an NPM1 mutation was observed. Several tumour suppressor genes demonstrate an increase in methylation and a corresponding decrease in expression in tumor tissues.
14 In humans, this methylation involves the activity of a group of enzymes referred to as DNA methyltransferases (DNMTs), which catalyse the transfer of a methyl group to a cystine base in newly synthesized DNA. Several DMNTs are over-expressed in tumour tissues and DNMT inhibitors have activity in the treatment of myeloid malignancies.15,16 Interestingly, we observed a decrease in expression of DNMT3B in subjects with favourable prognosis compared to NK-AML subjects. A decrease in expression of DNMT3A and DMNT1 in NK-AML subjects harbouring an NPM mutation compared to those without an NPM mutation is also observed (data not shown). This suggests DNMT activity may be decreased in the two AML cohorts associated with improved prognosis (favourable cytogenetics and NK-AML with a NPM mutation).
Despite DNMT inhibitors showing potential for the treatment of AML, the use of these treatments is limited by their lack of specificity and cytotoxic effects.17�C19 Therefore, the identification of downstream genes whose reactivation may improve prognosis is desirable and is the focus of this study. Subjects in the favourable risk group were first compared to NK-AML subjects and 594 CpG islands were significantly different between the two groups. Whilst the methylation status was similar across all subjects in the favourable risk group, the NK-AML subjects displayed marked diversity in methylation status. This is reflective of the diverse molecular abnormalities observed across NK-AML patients and corresponds to heterogeneity in gene expression seen in this subgroup of patients.
20 Gene ontology analysis of the gene list that displayed decreased methylation and increased expression in the favourable risk group compared to NK-AML GSK-3 subects revealed that six of the top ten processes enriched in the list were involved in developmental processes (data not shown), a process that is disrupted in AML. Key signaling pathways involved in hematopoietic development include the Wnt and the TGF-�� pathways.21,22 A major component of the canonical Wnt pathway is the transcription factor LEF1.